Posters

Unusual case of severe cicatrizing keratoconjunctivitis

Poster Details

First Author: M.Bilen Babic CROATIA

Co Author(s):    M. Merlak                    

Abstract Details

Purpose:

We present a case report of unusual bilateral chronic cicatrizing conjunctivitis with bilateral symblepharon formation and severe inflammatory changes with keratopathy, conjunctival-corneal scarring and ankyloblepharon formation in more affected left eye. Patient has previously diagnosed bilateral glaucomatous optic atrophy with severe glaucomatous damage in right eye and anamnestic allergy to many topical ophthalmic preparation. We present clinical features, our diagnostic algorithm and  management with reference to potential causes of chronic cicatrizing conjunctivitis.

Setting:

In January 2019 84 -year-old chronic glaucoma patient presented with symptoms of severe bilateral visual impairment of only light perception, eye redness and discomfort during last 1 year at emergency ambulance of  Department of Ophthalmology Clinical Hospital Center Rijeka, Croatia.  Following examination, diagnostics and treatment were performed.

Methods:

Our management included complete clinical examination, fotodocumentation, B-scan, conjunctival bacterial and fungal cultures, complete blood count, metabolic profile, rheumatoid factor, ANA and ANCA. Excisional biopsy of corneal-conjunctival membranes in left eye reported  mononuclear epithelial and stromal inflammation with reactive epithelial cell atypia. Applied therapy included: oral doxycycline 100 mg per day, oral corticosteroids gradually tapered, topical antibiotic and steroid dexamethason drops, topical lubricants and radical lid hygiene. Our surgical treatment in left eye consisted of conjuctival-corneal membranectomy and superficial fibrovascular tissue removal with fornix incision for symblepharon release and amniotic membrane transplantation.

Results:

Results of laboratory tests were negative. Immunofluorescent probing was required for the ocular cicatricial pemphigoid verification which reported low positive basement membrane reaction, scarring and profuse eosinophilic inflammatory reaction. Oral corticosteroid therapy was continued. Patient has now been followed-up for 1 month with stabilization of clinical picture and improvement of visual acuity in left eye to 0,05. Patient will be carefully monitored for following period.

Conclusions:

Chronic cicatrizing conjunctivitis can be caused by different demanding conditions as: ocular cicatricial pemphigoid, rosacea, atopic or epidemic keratoconjunctivitis, trachoma, Sjögren's syndrome, Stevens–Johnson syndrome, but in terminal stages of disease there are limited treatment possibilities.

Financial Disclosure:

None